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CHEST                                                                 289

him. The truck squeezed the front of his chest, scraping the skin, but causing
no further apparent local injury. He was in bed for two weeks and resumed
work atter three weeks. Alter three days' resumption of work he felt unable
to continue, his chief complaint being pain in the chest. He was confined
to bed again for two weeks, during which his pulse rate rose gradually from
30 to 60. He appeared to be progressing favourably when he suddenly died.
Post-mortem examination revealed no injury of any part of the chest wall
except the scraping of the skin. The pericardium was intact and full of
blood. No disease of the heart substance was found. The left ventricle alone
was injured. Its wall was bruised in five places, three in front and two
behind. The largest bruise, the size of a shilling, and extending through the
greater part of the wall's thickness, was found near the apex. Here the
ventricle wall was ruptured.

Gunewardane 30 reports the case of a boy, aged 9, who survived ten days
after sustaining injury to the heart owing to his chest having been pressed
against a wall by the back of a double-bullock cart. No external mark of
injury or fracture of the ribs was evident at the time of the accident. He
felt quite well the following morning, and was, therefore, allowed to go to
school, where he took part in the usual games. On the tenth day, while
playing at school, he complained of precordial pain and fell down dead.
Autopsy revealed a haemopericardium. On removal of the clot rupture of
the anterior surface of the left ventricle was seen. The slit was blackish-
grey, roughly circular, and about 1" X I" in diameter. The rupture was
probably due to the contusion of the heart wall at the time of the accident
and yielding of the muscles so damaged.

The heart may be torn asunder from its vascular attachments by a crush-
ing force which compresses the chest violently and drags the organ down-
ward. Khosla 31 reports a case in which a woman, about 60 years old, died
,soon after she was run over by a military truck. On post-rnortem examination
the upper five ribs from the second to the seventh were fractured along the
nipple line on both the sides. The body of the sternum was fractured trans-
versely. The pleural cavities were full of fluid blood. The heart was found
lying free in the left pleural cavity. It was detached completely from its
vascular attachments. A rent, about three inches long, was noted on the
left side of the pericardium parallel to the vertebral column.

Blood Vessels.óWounds of the aorta or the pulmonary artery are rapidly
fatal. Wounds of the smaller arteries may prove fatal on account of profuse
bleeding. Wounds of the large veins, especially of the neck, chest, axilla or
groin, may result in death from the air entering the blood and consequently
passing into the right side of the heart.

Rupture of the aorta may be traumatic or spontaneous. When due to
trauma the rupture is often localized just above the valves, and is more
frequently transverse than longitudinal.

A thin man, aged 45, died immediately after he was hit with a lathi over the left
side of the chest. The aorta, which was almost completely calcified, was found ruptured
at the junction of the transverse and descending parts. There was no injury to the
chest or to the ribs.

Accidental rupture of the aorta may occur from an impacted foreign
body in the oesophagus piercing the wall of the aorta.

A case32 is recorded in which a fisherman, aged 22 years, died on the third day-
after swallowing a fish bone.   At the post-mortem examination a fish bone was fo
impacted in the oesophagus at about the level of the bifurcation of the bronchus,   "
upper end of this bone, which had a sharp point and a sharp edge, had made a

30.   Brit. Med. Jour., Nov. 24, 1934, p. 942.

31.   Ind. Med. Gaz., Sep. 1948, p. 419.                                                      v

32.   K. C. Jacob and C. B. Gopalkrishna, 'Ind. Med. Gaz., Nov. 1952, pp.